Schwitzer health news blog

NY Daily News story on breast reduction surgery not up to challenge

In one of the worst examples of disease-mongering we've ever seen, the paper let a plastic surgeon get away with saying, “The pain that women with large breasts can have has been compared to when someone gets metastasized cancer of the spine.”

Stumble It!

Bipolar children a purely American phenomenon

Christopher Lane interviews journalist Philip Dawdy, who has written about the "astonishing" rise in the number of diagnoses of ADHD and bipolar disorder in teens and preschoolers.

Stumble It!

ABC's disease-mongering of toenail fungus

I'm breathless.

Almost 5 minutes of network airtime to discuss a "new cure" for toenail fungus.

How was it disease mongering?

• ABC said, "About half of all Americans over the age of 50 are struggling with this problem." Struggling? Really? Enough to warrant a $1200 treatment ($120 per toe) that is NOT covered by insurance (thank God)? This is part of the 16% of the GDP that Americans spend on health care.

• ABC profiled one woman: "Meghan, like millions of Americans, has had her toe fungus for 15 years. It's unsightly, embarrassing. And like others, she suffered in silence, not wanting to talk about it." Millions of us like poor Meghan - suffering in silence? But not silent any longer - thanks to almost 5 minutes of network news time.

A physician promoting the laser on the program offered up this clear-as-mud analysis:

"Long-term studies need to be done. Studies have only been done since 2007. It was FDA-cleared in 2008. And I want to make it clear that this is an off label use right now.”

So long term studies need to be done. But it's been FDA "cleared". But it's an off-label use right now - meaning it hasn't been cleared for this use. HUH??????

And does anyone at the FDA care about such blatant off-label marketing on network TV.?

Stumble It!

Overactive marketing for overactive bladder

A classic example of disease mongering. That's what blogger John Mack writes on his Pharma Marketing blog - about a slide presentation he found from a drug company exec pushing the drug, Detrol, for overactive bladder.

Mack writes:

"I remembered being present at the 2002 meeting and how shocked I was that a pharmaceutical VP would actually be so transparent in discussing how "overactive bladder" was a "new" disease that he and his company created specifically to increase the sales of Detrol!"

In her book, "Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs," Melody Petersen wrote that too many journalists fall too easily into drug company plans to create a market for a drug – citing the coverage of Detrol. “Dozens of journalists at newspapers and television stations across the country wrote stories about the disorder said to be destroying the lives of millions of Americans,” she writes. “Editors and television news directors loved these reports. Silly stories of people running to the toilet brightened the day’s news.”

Stumble It!

Disease-mongering by the Washington Post: here we go again

There are WMD’s lurking inside your body. And you better find them ASAP.

In its health section today, the Washington Post gives men of all ages screening test advice – much of it not grounded in the best medical evidence or at least not reflecting real controversies in health care.

They do one of those “What To Do In Your 20s, 30s, 40s, 50s…” columns that news organizations find so appealing and that I find so incomplete.

Sanjay Gupta and CNN have done the same thing

So has the Star Tribune and many other news organizations.

Among the questionable advisories from the Post:

• Telling men in their 30s to “sign up for complete physicals”
• Telling men in their 40s to get a complete physical every two years

There was no mention of the controversies surrounding such recommendations - some experts calling it wasteful.

• Telling men in their 40s to start skin cancer screening.

Aren’t they aware that the US Preventive Services Task Force just last week stated :

“ the current evidence is insufficient to assess the balance of
benefits and harms of using a whole-body skin examination by a
primary care clinician or patient skin self-examination for the
early detection of cutaneous melanoma, basal cell cancer, or
squamous cell skin cancer in the adult general population.” ???

They go on to tell men in their 50s to have prostate cancer screening. (They do say the pros and cons should be discussed, but the recommendation for such screening stands nonetheless.)

Again, the USPSTF states: “the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.”

What the Post promotes may be one doctor’s – or some doctors’ - opinion(s). But for a major newspaper to state these as if they were handed to Moses on stone tablets is wrong. There are uncertainties. There is controversy. Screening tests can cause harm - not just benefit. And good journalism should reflect that.

Stumble It!

Too many "check engine" lights on the human body

"You are pre-diseased." That's the title of a CBC radio program with Alan Cassels exploring "the gestalt of our time in a world where, it seems, more and more overdiagnosis is becoming the norm, where everyone is, more or less, prediseased."

(Part one airs tomorrow night - part two next week.)

Cassels interviews Dartmouth's Gil Welch, who says:

"I think the generic problem is somewhat like the "check engine" lights on your car. Do you have check engines lights? My first car was a '75 Ford Fairlane. There were only two things monitored: my oil pressure and my engine temperature. I now drive a Volvo that is 10 years old, but it is checking about 25 different engine functions. And sometimes a check engine light comes on, and you’re really glad to know, and it leads to something you want to do something about. Sometimes the check engine light is just a nuisance, and it just keeps flashing on and off and the mechanic can’t fix it. And some of the audience might have this experience where they went to get it fixed and it made matters worse. And if you had that experience, you’ve had some of the experience of overdiagnosis and that’s what I’m worried about. We’re putting more and more check engines lights on the human body. We have to ask ourselves if that is really the best way to get to a healthy society. We’re constantly monitoring for things to be wrong. Is that really the best way to achieve health?"

Stumble It!

Yes, still another case of "journalist" pro-screening bias

Over on the HealthNewsReview.org website, we've reviewed another example of a journalist giving pro-screening test advice that is not supported by medical evidence.

This time it was the CBS Early Show, using physician-"reporter" Dr. Holly Phillips from WCBS-TV in New York to do a followup on actress Christina Applegate's diagnosis of breast cancer.

We said in that review:

The story engages in disease-mongering in its conclusion: "What's most important is to screen. One in eight women nowadays is going to get a breast cancer in her life, so as long as you get in for screening, I'm happy." The 1 in 8 statistic requires explanation. It is a lifetime incidence estimate. Many women misinterpret this to think that they have 1 in 8 chance right now at this time in their life. It is one of the misused and most misunderstood statistics in health care. The National Cancer Institute estimates that a typical 40-year old woman has less than a 2% (1 in 50) chance of developing breast cancer before 50, and less than a 4% (1 in 25) chance of developing it before age 60.

But the story also states, "But generally, we start home breast exam at age 20. I suggest every month, at the same time of the month, examine your breasts at home and get into your doctor for a breast exam at least every three years, earlier if you can." This is not an evidence-based recommendation and involves a physician-reporter giving personal advice and perhaps forgetting that she is now a reporter.

There is little evidence that breast self-examination (BSE) lowers deaths from breast cancer, and SBEs are not recommended by themselves for detecting breast cancer, especially in higher-risk women.

Experts disagree that mammography screening "should begin at 40", especially for women at low to average risk. See: http://www.annals.org/cgi/reprint/146/7/I-20.pdf .

The story had many of the elements of today's TV health stories:

• a young female celebrity angle
• a young female physician-reporter
• fear and promotable content.

Unfortunately, as with many of today's TV health stories, it also lacked details on evidence.

Stumble It!

Olympians pushing Botox - an "outrageous caper"

Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen, released this statement yesterday:

"It is a sad day when two superb Olympic athletes - whose performances earned a total of 14 gold medals combined - prostitute themselves for undisclosed amounts of money to help Allergan sell Botox. Instead of tens of millions of people watching the athletes’ performances in the past as they strived for their personal best, people will now be able to watch videos of doctors’ performances as they inject former swimmer Mark Spitz and former gymnast Nadia Comaneci with Botox.

This sends a terrible message to athletes, young or old, and to others that they should not accept the way they look as they age but, rather, should try to look their "personal best" by the Botox-enhanced pretense that they are younger than they really are.

Another trouble with this slick marketing campaign is that botulinum toxin (available as Botox and Myobloc) can cause life-threatening adverse reactions. In January, Public Citizen petitioned the Food and Drug Administration (FDA) to immediately increase its warnings about Botox and Myobloc; adverse reactions can include paralysis of the respiratory muscles and difficulty swallowing (dysphagia), a condition that can allow food or liquid to enter the respiratory tract and lungs, causing aspiration pneumonia. While the data in our petition mainly related to problems associated with the medical use of Botox, adverse reactions can occur with cosmetic use as well. Since when did "personal best" involve subjecting oneself to a risky procedure?

Two weeks after we filed our petition, the FDA issued a press release warning of the dangers of injecting botulinum toxin but stopped short of forcing drug makers to send out warning letters to doctors or putting a black box warning on the drug as we had requested.

By peddling a product that can seriously injure people, these athletes are tarnishing their past athletic achievements. Botox is nothing to play around with. The public should not be lulled into a false sense of security by Allergan’s outrageous caper."

Read the Allergan news release for a lesson in disease-mongering and marketing. They're coining a new condition called "The 11" - as explained by Comaneci: "About five years ago, I realized that while I exercised and ate right most of my life, there was nothing I could do on my own that would get rid of those two stubborn frown lines stamped on my forehead. They looked like an '11' and made me upset with the way I looked, and that's when I decided to talk to my physician about BOTOX(R) Cosmetic treatment. I attained a perfect '10' at age 14, and I'm working hard to stay close to that in all that I do." Then they go on to describe "How the '11' makes people feel." Including Spitz saying, "As a financial advisor and motivational speaker, my facial expression is a very important part of my message. When I am serious, my '11' makes me look angry and unapproachable rather than congenial. I knew I had to do something about it, but for a long time, I just didn't know what my options were. Then I heard about Botox."

I've always loved the Willie Nelson song lyrics:

This Face is all I have, worn and lived in
And lines below my eyes are like old friends...
This face of mine
And I kept believing the reflection on the wall
Who needs to be the fairest of them all
I never looked like you, cool and streamlined
I have this honesty that grows with time
And when cracks appear they suit me fine
Like a good old dog you won't hear me whine
And this face is all I have, worn and lived in.

Stumble It!

Disease-mongering by Russert pundits

There has been a lot of speculation about what happened to and what could have saved Tim Russert.

Some, like a Wall Street Journal piece, "A Visceral Fear: Unexpected Heart Attacks," bordered on disease-mongering. That story discussed:

"...experts who think wider use of coronary calcium CT scans could help spot more people at risk of soft-plaque blockages. The noninvasive procedure takes about 15 minutes and costs a few hundred dollars. But few insurers cover it because there is scant evidence that treating people on that basis saves lives.

At a minimum, seeing a picture of the calcium lining their arteries can be a wake-up call for patients to take their coronary-artery disease seriously and to be diligent in taking medication, exercising and making other healthy lifestyle changes."

I'm sure there are such experts. But there are many other experts who do not support wider use of such scans. It's not just insurers who are reluctant. The story makes the procedure sound quick and inexpensive. But that is on the individual level. Who should be screened? Everyone over 40? The entire population?

Pictures - even those of the insides of our coronary arteries - don't tell the whole story. And neither did this piece.

Stumble It!

Disease-mongering: Let's all be worried about our plaque buildup

Reuters was among those reporting on the latest recommendation to put more Americans on statins to lower cholesterol. The story states: "The number of U.S. adults on cholesterol-lowering medication could rise by one-quarter to one-half if doctors were to routinely scan adults' arteries for plaque buildup, a study suggests." The study was by a task force called SHAPE.

But Reuters importantly concludes the story by pointing out that authors of an editorial accompanying the study in the Archives of Internal Medicine "question where the task force's funding came from, and whether "conflicts of interest might bias the authors' judgment."

The recommendations provide "food for thought," the editorialists write. "But as a guideline for clinical use, SHAPE does not shape up."

That won't stop drug companies from disease-mongering. This ad would have us worried every second about the plaque that might be building in our arteries - silent, stealthy, sinister. Just like drug ads - trying to increase market share and instill fear into the worried well.

Stumble It!

Disease mongering by Women's Health magazine

Add Women's Health magazine to my list of publications guilty of disease-mongering by advocating tests that are not supported by evidence - recommendations that run counter to those of the U.S. Preventive Services Task Force.

The article, "THE MEDICAL TESTS YOU SHOULD TAKE: Head-to-Toe Tune-Up" is not unlike those I've criticized on CNN, in the Minneapolis Star Tribune, and in a number of other news outlets.

No source is given for the recommendations.

Journalists: when you promote testing and screening in healthy populations in the absence of evidence of benefit and in the presence of known harms you may be causing harm yourselves. And you're certainly stirring up the "worried well" to seek medical attention when they may not need it. We're already devoting 16% of the gross domestic product to health care.

Stumble It!

Stop running scared

Shannon Brownlee on disease-mongering.

Stumble It!

The nasty bloodsucking bedbug epidemic

If you survived the last TV ratings period and DIDN’T see a story about the horrible epidemic of bedbugs right in your town - maybe right in your own bed - then just stay tuned until the next sweeps period.

David Segal of the Washington Post was on NPR’s “On the Media�? program talking about the hyperbolic news coverage of the bedbug panic.

Stumble It!

More on news organizations promoting unnecessary testing

A physician who teaches evidence-based medicine, and who is also a freelance health journalist, has been reading my thoughts about journalists advocating screening tests in the absence of evidence.

She wrote me: "Here's one of the more annoying recent examples, one that I actually used in class to illustrate the issue of patients coming in and requesting specific tests based on what they read in the newspaper."

So I'm adding Parade Magazine to my list of offenders.

Stumble It!

Here we go again - another industry-funded Sleep Awareness Week

Don't let the special interest campaign catch you napping!

Dozens upon dozens of stories about Americans lacking sleep are popping up from news organizations all over the country this week, driven by another of the National Sleep Awareness Week campaigns of the National Sleep Foundation.

Few - if any - of these stories will tell you that it is industry special interests - sleeping pill makers, sleep labs, mattress makers - who are paying for this campaign. They do it every year. And news organizations fall into line like sheep and report the "new" findings every year.

Examples:

USA Today reports:

U.S. workers are silently suffering from a dramatic lack of sleep, costing companies billions of dollars in lost productivity, says a study out Monday.

Nearly three in 10 workers have become very sleepy, or even fallen asleep, at work in the past month, according to a first-ever study on sleep and the workplace by the non-profit National Sleep Foundation. The late-2007 survey was based on a random sample of 1,000 workers.

AP reports:

Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.

CNN, WebMD, UPI, the St. Louis Post-Dispatch and many, many more news organizations are reporting the same stuff - handed to them by the industry-funded campaign.

Yawn.

Wake me when the next disease-mongering campaign comes around.

Stumble It!

More journalistic disease-mongering

The Star Tribune newspaper has a feature story entitled, "How to be a screen queen."

Its primary focus is to remind women of all the screening tests they should have, but they also have a sidebar on men's screening test recommendations.

The problem is that many of the recommendations listed are controversial and are not supported by the
U.S. Preventive Services Task Force. (Even though the paper lists the USPSTF as one of its sources!)

I won't write anything more about this for now because I'm going to submit an op-ed piece to the paper. I'll let you know if it is published.

Stumble It!

Promoting obsession with health test scores

Two TV health segments that I'm sure were well-intentioned both caught my eye this week for how they might lead viewers to obsess about still another score, still another test result, still another number that they don't fully understand.

The CBS Early Show had a series entitled, "Early Intervention: Cardiac Arrest." Their reporter went around to food courts in shopping malls "seeking people eating unhealthy foods, or who were overweight, or who had other potentially problematic signs, and offered to check out their heart disease risk. They agreed to undergo CT scans to help assess their heart health. The doctors checked the images the scans produced for signs of calcium, which indicates the presence of artery-clogging plaque."

Before it was all over, the series made it sound like most of us should be running in for a CT scan and that we should certainly know our "calcium score" - a test result that was drummed into viewers over and over. Only briefly did I hear the caveat that these tests are only for people with risk factors including a family history of heart disease. But the caveat was rushed and unclear. CBS' website even states:

If you live in the Memphis area and want to have a scan to check on the calcium levels in your cardiac arteries, call (901) xxx-xxxx. (I have no intention of furthering the promotion by providing the phone number as CBS did.)

That sounds like an all-out invitation to all viewers, doesn't it?

Then CNN's Housecall program this weekend reported on one of the many tests being developed to screen for early Alzheimer's disease. The story said:

"Researchers are hoping to get the Detect system into doctor's offices as early as this fall. It will be used as an early screening tool starting around the ages of 45 to 50. The goal here would be to get a baseline of your cognitive skills early on, so doctors can act early if a drop in score is detected."

Well, sure they're hoping to get it into doctor's office this fall to start screening everyone around 45-50. What a huge new market. And let's get hundreds of thousands of more Americans worrying now about their baseline "cognitive skills score" or whatever it would be called. Meantime, there was no discussion of the sensitivity or specificity of the test. It was still another example of accepting claims about a new screening test without exploring any of the pitfalls, the downsides, the things that come from such screening that can have harmful effects on peoples' lives.

Calcium scores and cognitive skills scores: two more things to worry about, two more ways to promote fear in all of us and to "sell sickness." And two more examples of journalists not asking enough tough questions.

There's an old line that the only well person left in America is simply someone who hasn't been tested enough. Because the more you look, the more you'll find.

Stumble It!

Nothing but miracles, breakthroughs, rainbows & unicorns for TODAY Show

Last week the NBC Today Show presented a series it called “Mini Medical Miracles.�?

Were you waiting for news on cancer? Heart disease? Diabetes? Infectious diseases?

Sorry. What you got was baldness, insomnia, dandruff and wrinkles.

But NBC called the approaches “miracles�? and “breakthroughs.�? Man, that’s what we need is a good miracle for dandruff and wrinkles.

Anchor Matt Lauer led into the wrinkles story by asking “Could having a new laser treatment in your forties or fifties prevent you from ever needing a facelift?�?

Who says that anyone needs a facelift? Facelifts are a matter of want, not need.

47-million uninsured is a matter of need.

Lauer and NBC medical editor Dr. Nancy Snyderman could barely contain their enthusiasm for the laser “treatment.�?

(Snyderman:) “This is going to be in your doctor’s office soon.�?

(Lauer:) “It’s interesting. And anything that keeps people away from the knife. I mean, that’s major surgery.�?

(Snyderman:) “I think you can say to people, this is a preemptive strike and it’s taking care of your skin and you can avoid a real operation. There will be a lot of people, men and women, who will be interested.�?

There was no discussion of evidence, no quantification of benefits or harms, no discussion of how long the approach has been tested nor in how many people.

On HealthNewsReview.org the story is one of only 10 of the first 500 stories reviewed that got a score of 0.

Oh, for the good ol’ Today Show days of Dave Garroway and J. Fred Muggs, the chimp.

Stumble It!

Is the obesity "epidemic" exaggerated?

See the online debate in the BMJ.

YES it is.

NO it isn't.

Stumble It!

Another new disorder - another use for an old drug

News coverage has already begun for a newly-named disorder that has a handy acronym for a name and - lo and behold - has a drug ready to treat it.

It's called PGAD or persistent genital arousal disorder and Paxil has been mentioned as a treatment.

Blogger John Mack writes that "GlaxoSmithKline, which makes and markets Paxil, is the same company that brought us Requip for RLS! Coincidence? I think not!" And Mack, in his blog entry headlined, "PGAD. EGAD! Another Syndrome/Disorder, Whatever!" offers a storyboard for the TV drug ad he envisions for Paxil for PGAD.

Stumble It!

Microbe-phobia reaching a fever pitch

The Wall Street Journal reports on "a slew of new cleaning products aimed at germ-phobic homeowners."

Much of it plays on the fears consumers may have over E. coli or MRSA.

The story describes products using silver ions, copper oxide, steam, triclosan or ultraviolet light to kill bugs.

Wow. I like soap.

Stumble It!

Disease-mongering of constipation

Blogger John Mack writes about the marketing of the drug Amitiza. He says the drugmaker, Takeda, engages in disease-mongering with a claim he found on the Amitiza website: "Chronic Constipation touches the lives of up to 28% of adults in America. Both men and women suffer from it, but the condition is two to three times more common in women."

Mack responds:

"What exactly "touches upon" means is anybody's guess. Nevertheless, the 28% figure is dutifully repeated in media stories.

In fact, the media go even further and cite these numbers given to reporters by Takeda: "Constipation affects 42 million American adults, and 12 million could be characterized as suffering from chronic idiopathic constipation, the condition for which Amitiza is indicated..."

Let me whip out my trusty Microsoft desktop calculator and do some math.

How many US adults are "touched upon" by "chronic constipation?" There are about 220 million US adults over the age of 20. 28% of that equals about 62 million people. Clearly, that's a much greater number than 42 million adults that are said to suffer from simple "constipation" and much greater than the 12 million sufferers of "chronic idiopathic constipation," which is a form of constipation having an unknown cause. The latter is the "official" FDA approved indication for Amitiza. All the other numbers about simple constipation and "touched upon" seem to have been thrown in to confuse us into thinking that this drug is indicated for a much larger population than the FDA gives it marketing approval for."

So prepare for your TV shows and your Reader's Digest to be blocked up by new ads for this constipation drug.

Stumble It!

Are you anxious?

Dr. Sanjay Gupta’s HouseCall program on CNN today featured a story on anxiety disorders, and offered one of those handy self-assessments that allows you to diagnose yourself with almost anything under the sun.

Gupta said only one in five people with anxiety disorders get help. Then he offered a self-assessment from the Anxiety Disorders Association of America (ADAA). Gupta listed:

Do you have a (sic) anxiety problem?
• Excessive worry, occurring more days than not, for a least six months?
• Unreasonable worry about a number of events or activities, such as work or school and/or health?
• The inability to control the worry?

He said if you answered yes to any of these, you could seek help from your doctor or from ADAA.
He did not mention that the ADAA’s corporate advisory council is made up of drug companies Eli Lilly & Company, Forest Laboratories, Pfizer, Inc. and Wyeth.

I worry a lot about how commercial, how unquestioning, and how cheerleading much of CNN’s medical news is. It makes me very anxious and I am unable to control that worry. It only gets worse.

Stumble It!

New drug "Havidol" - when more is not enough

Have you heard about the blockbuster new drug, Havidol?

Its creators say that HAVIDOL is for the treatment of Dysphoric Social Attention Consumption Deficit Anxiety Disorder (DSACDAD). And they say it is the only known medication available for this newly recognized disorder.

Details at Havidol.com.

It's also a spoof.

The creator of the campaign, an Australian artist, tells Reuters that many people don't get the fact this is a parody or satire. This reminds me of the spoof a few years ago on Motivational Deficiency Disorder mentioned on this blog.

I am pumped. The Havidol website tells me: "No prescription drug can promise endless happiness. However given HAVIDOL's track record, and Future PHARMS (the manufacturer) commitment to perfecting life through chemistry, terminal happiness has become a real possibility."

Stumble It!

An epidemic of diagnoses

Dartmouth and VA researchers Gil Welch, Steve Woloshin and Lisa Schwartz have an essay in the New York Times that begins: "For most Americans, the biggest health threat is not avian flu, West Nile or mad cow disease. It’s our health-care system."

They go on to state: "More and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses." They describe the "medicalization of everyday life," wherein "everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction. Perhaps most worrisome is the medicalization of childhood. If children cough after exercising, they have asthma; if they have trouble reading, they are dyslexic; if they are unhappy, they are depressed; and if they alternate between unhappiness and liveliness, they have bipolar disorder. While these diagnoses may benefit the few with severe symptoms, one has to wonder about the effect on the many whose symptoms are mild, intermittent or transient."

They look at increasing questionable use of CT scans, ultrasounds, M.R.I. and PET scans.

And they address the lower thresholds for defining disease. "Thresholds for diagnosing diabetes, hypertension, osteoporosis and obesity have all fallen in the last few years. The criterion for normal cholesterol has dropped multiple times. With these changes, disease can now be diagnosed in more than half the population."

They conclude: "Perhaps someone should start monitoring a new health metric: the proportion of the population not requiring medical care. And the National Institutes of Health could propose a new goal for medical researchers: reduce the need for medical services, not increase it."

Stumble It!

Dangerous "off-label" drug promotion campaign

The New York Times reports that drugmaker "Eli Lilly encouraged primary care physicians to use Zyprexa, a powerful drug for schizophrenia and bipolar disorder, in patients who did not have either condition, according to internal Lilly marketing materials."

The Times reports the campaign was first called "Viva Zyprexa." "Lilly considered ways to convince primary care doctors that they should use Zyprexa on their patients. In one document, an unnamed Lilly marketing executive wrote that these doctors 'do treat dementia' but 'do not treat bipolar; schizophrenia is handled by psychiatrists,' " according to the Times report.

The Times explains: "The issue of off-label marketing is controversial in the drug industry. Nearly every company is under either civil or criminal investigation for alleged efforts to expand the use of its drugs beyond the specific illness or condition for which they are approved. Lilly faces federal and state investigations over its marketing of Zyprexa."

The paper also reports that sales of Zyprexa doubled between 1999 and 2002, rising from $1.5 billion to $3 billion in the United States.

A primer on off-label drug use and promotion is available on the HealthNewsReview.org website.

Stumble It!

Two recent examples of disease-mongering

We have screening tests that find "pre-cancerous" conditions - the true danger of which we know little.

We have defined a new category of "pre-hypertension" - labeling millions more Americans with "a condition."

And now read this column claiming that one in six Americans - "54 million of us" - have "pre-diabetes."

I am relieved to see one journalist who caught disease-mongering in full bloom. Pam Kelley of the Charlotte Observer was peeved by a Wall Street Journal health column on "female sexual dysfunction." In her article, "Don't tag all libido swings as disorders," Kelley wrote that the WSJ column "cites a study that found 42 percent of women in early menopause 'had scores indicating sexual dysfunction.' In late menopause, 88 percent 'had scores below the cut-off for sexual dysfunction.' "

Kelley continued, "Why does a decline in sexual desire mean you're dysfunctional? And if almost everyone in a study -- 88 percent -- scores the same way, how come they're the dysfunctional ones?"

More journalists and more consumers need to be armed for the onslaught of disease-mongering campaigns - some from well-intentioned caregivers and some from profit-motivated drug companies.

Stumble It!

Cholesterol TV ads clog reality

How can you argue with ads for a drug attacking America's leading killer?

Easy - when you base the argument on facts and evidence rather than emotion and fear-mongering.

Canadian drug policy analyst Alan Cassels writes about disease-mongering in ads for cholesterol-lowering drugs such as Pfizer's Lipitor, the #1 selling prescription drug. He writes: "What most people won’t learn from such ads is that when scientists have done meta-analyses (a study of a collection of studies) of the largest statin drug trials, they inevitably find that the drugs show no difference in mortality, when compared against placebo. There may be some changes in heart attack rates, but no changes in overall deaths, which is what the ads are all implying. We don’ t call this disease avoidance, we call it disease substitution. The drug may prevent a heart attack death but in the process will cause other kinds of deaths, a sort of zero sum gain that is the equivalent of taking an expensive placebo."

Cassels writes about one Pfizer Lipitor ad that shows the tagged toe of a corpse. “What would you rather have, a cholesterol test or a final exam?�? asks the headline. Cassels says "The key message is that getting a cholesterol check and then, probably taking drugs to alter your cholesterol, will prevent a premature death. Even, if you are otherwise healthy."

Stumble It!

Restlessness over restless leg syndrome drug promotion

The Sunday Times of Great Britain reports:

"The pharmaceutical giant Glaxo Smith Kline (GSK) has been reprimanded by an industry watchdog for promoting an unlicensed drug to treat the disputed condition of restless legs syndrome. ... Some doctors claim the condition ... has been concocted or at least exaggerated to help sell drugs. While patients had previously complained to doctors of leg cramp at night, few had heard of restless legs syndrome before drugs became available to treat the illness."

It's interesting to see how another country deals with drug ads. Of course, the U.S. is only of only two industrialized countries in the world to allow direct-to-consumer prescription drug ads. And, of course, restless drug ads have filled American media for a long time.

Dartmouth and VA Outcomes Group researchers Woloshin and Schwartz recently published "Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick" in PLoS Medicine. Their analysis of news coverage of "restless legs" led to this conclusion: "The news coverage of restless legs syndrome is disturbing. It exaggerated the prevalence of disease and the need for treatment, and failed to consider the problems of overdiagnosis. In essence, the media seemed to have been co-opted into the disease-mongering process. ... The stories are full of drama: a huge but unrecognized public health crisis, compelling personal anecdotes, uncaring or ignorant doctors, and miracle cures.

We think the media could report medical news without reinforcing disease promotion efforts by approaching stories like 'restless legs' with a greater degree of skepticism. After all, their job is to inform readers, not to make them sick."

Stumble It!

Disease-mongering and female sexual dysfunction

How do you treat what you can't define? Never a question to stop drug companies.

Many have pursued a drug for so-called female sexual dysfunction or FSD. Pfizer recently announced that Viagra (the erectile dysfunction drug) increased vaginal blood flow in rats, so they're continuing to test it with hopes it could help women whose "female sexual dysfunction" is caused by that problem.

Not everyone buys into the FSD picture. In their book, "Selling Sickness," Ray Moynihan and Alan Cassels interview NYU psychologist Leonore Tiefer, who challanges the medicalization of women's sexual difficulties. She says, “Your body isn’t good enough. You aren’t good enough. You plus products…now maybe then you’re good enough." The authors write: "If there was no agreement on how to define or measure FSD, how on earth could a company show in a clinical trial that its drug had helped fix the dysfunction? If you can’t measure it, how can you market a pill to fix it?

One "probability sampling survey" published in the Journal of the American Medical Association 7 years ago estimated that 43% of U.S. women have sexual dysfunction. That authors of the "Selling Sickness" book say that estimate "will likely go down in history as one of the most abused medical statistics of our time."

But the estimate - weak though it may be - helps, if your goal is selling sickness.

For more on disease-mongering, see the website of this past year's Conference on Disease-Mongering in Australia.

And don't miss a special collection of articles on disease-mongering in PLoS Medicine.

Stumble It!

The Fight Against Disease Mongering

Australian journalist Ray Moynihan and Professor David Henry are the guest editors of the April 2006 theme issue of PLoS Medicine on disease mongering. They also just hosted an international conference on the topic.

They write: "In our view, disease mongering is the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments. It is exemplified most explicitly by many pharmaceutical industry–funded disease-awareness campaigns—more often designed to sell drugs than to illuminate or to inform or educate about the prevention of illness or the maintenance of health. In this theme issue and elsewhere, observers have described different forms of disease mongering: aspects of ordinary life, such as menopause, being medicalised; mild problems portrayed as serious illnesses, as has occurred in the drug-company-sponsored promotion of irritable bowel syndrome and risk factors, such as high cholesterol and osteoporosis, being framed as diseases."

PLoS Medicine is publishing several other articles on disease-mongering in the new special issue. Go to their website to see all of them.

PLEASE NOTE: disease-mongering will be one of the things we look for in a new U.S. website that evaluates and grades U.S. health news coverage. The site will debut next Monday, April 17. It is http://www.HealthNewsReview.org. More details later.

Stumble It!

Making "extreme laziness" into a disease

Ray Moynihan reports in this week's BMJ on Australian scientists describing a new condition called "motivational deficiency disorder," for cases of extreme laziness.

The researchers claim the condition affects up to one in five Australians.

Of course, there's a drug attached to this research. They're studying indolebant in phase II studies, claiming that "one young man who could not leave his sofa is now working as an investment adviser in Sydney."

The researchers work in the University of Newcastle, where another professor, David Henry, is planning a conference this month on disease-mongering.

The conference agenda just got a bit longer.

I can't wait to see the ads for this one. I'm saving my spot on the sofa to watch them.

Stumble It!

National Sleeping Pill Advertising Week

This week you can expect to read and see countless news stories about "how sleep problems affect performance in nearly every aspect of teenage life – academically, psychologically and physically."

It's because of a promotional campaign called the 9th annual Sleep in America poll of the National Sleep Awareness Foundation.

They call it "National Sleep Awareness Week." I call it "National Sleeping Pill Advertising Week." The Foundation is run by drug companies that make sleeping pills, and by sleep lab operators and mattress makers. Not quite an unbiased source.

While the promotion will cite all sorts of statistics about sleep-deprived teens, they are not likely to brag about this: I read one estimate that the use of sleeping pills in kids ages 10 to 19 has skyrocketed 85 percent in recent years, with spending up 223 percent.

As a nation, we're spending billions on sleeping pills and drug companies are spending hundreds of millions to get us to use more.

That's what National Sleep Awareness Week means to me.

Stumble It!

Scientists say stop selling "metabolic syndrome"

The Reuters wire service reports that "the world's top two diabetes organizations have questioned the existence of a medical condition widely cited by drug firms, in a move that could hamper prospects for Sanofi-Aventis's new drug Acomplia. The American Diabetes Association and European Association for the Study of Diabetes said in a joint statement on Thursday that 'metabolic syndrome' -- which has come to be seen as a predictor of cardiovascular disease -- was poorly defined, inconsistently used and in need of further research. Doctors should not diagnose people with the 'syndrome' or treat it as a separate condition until the science behind it is clear, according to a paper to be published in the September issue of Diabetes Care and Diabetologia."

Reuters reports that the " strongly worded warning was a setback for Sanofi, which is keen to position its anti-obesity drug Acomplia as a medicine to treat 'metabolic syndrome.' "

"Metabolic syndrome" has been defined as applying to anyone with three or more of the following conditions -- a large waist circumference, high triglyceride levels, high blood pressure, low levels of HDL "good" cholesterol and high blood glucose.

The naming of new diseases and new syndromes to help sell drugs is well documented in books by Moynihan, Goozner, Avorn, Angell and others. It is refreshing to see scientists put up a STOP sign in at least one case.

Stumble It!

Selling Sickness

I just finished reading an important new book, "Selling Sickness: How The World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients," by Ray Moynihan and Alan Cassels.

It documents disease-mongering, how drug companies foster the creation of medical conditions to create markets for their pills, the marketing of fear, the "medicalization" of normal states of health, the hidden agendas of "disease-awareness campaigns," problems with drug company relationships with celebrity spokespersons and patient advocacy groups, and other issues about which most consumers don't have a clue.

As one skeptic says in the book, "We're changing the experience of what it means to be human."

It also points to numerous instances of what the authors call "sycophantic media coverage" and an "indictment of the flaccid culture of much medical reporting."

I highly recommend the book.

Stumble It!